Seizure‐Associated Headache in Epilepsy

Abstract

Summary:Purpose: Headache is often ignored as a symptom of epileptic seizures. The purpose of this prospective study was to analyze frequency, classification, and characteristics of seizure-associated headache (SH) according to the criteria of the International Headache Society.Methods: Over a period of 15 months, 341 patients with epilepsy, consecutively evaluated at our outpatient clinic for SH, completed a standardized questionnaire.Results: Of the 341 epilepsy patients, 115 (34%) experienced SH with a pain intensity of 6.1 ± 1.6 (SD) on the visual analogue scale and a duration of 12.8 ± 15.7 (SD) h. Seizures were always accompanied by headache in 69 (60%) of these 115 patients. SH occurred in four (3%) of 115 patients only preictally, in 31 (27%) of 115 patients periictally, and in 80 (70%) of 115 patients only postictally. In the majority of the 115 patients (55.7%), SH could be classified as migraine headache, whereas in 36.5%, as tension-type headache. The type of SH was not correlated with sex, an epilepsy syndrome, or a seizure type. Migraine-like SH was significantly associated with a history of migraine (p < 0.001). In 20 (77%) of the 26 patients experiencing migraine-like SH with a history of migraine, the phenomenology of migraine-like SH and migraine attacks was identical.Conclusions: SH is a frequent, long-lasting, and severe symptom of epileptic seizures, causing major impairment of daily living. A history of migraine significantly increases the risk for developing migraine-like SH.

Headaches add to the burden of epilepsy

“…Yankovsky et al found 48% [12]. In a study by Leniger et al, 56% of peri-ictal headache was classified as migraine [16], while Förderreuther et al reported 34% [7]. These findings are in accordance with our study.…”

“…Many authors have tried to explore this association, but with rather diverse findings. The prevalence of migraine in individuals with epilepsy varies from 2% to 24% [4,6,7,11,12,[16][17][18][19][20]. This large variation is probably due to differences in classifications of both disorders, as well as in the selection of patient populations and diagnostic instruments.…”

The Prevalence of Migraine and Tension Type Headaches among Epileptic Patients

“…Our results are close to the prevalence of 5-15% for pre-ictal headache that was reported in epilepsy and of especially 11% in pharmacologically refractory partial epilepsy (29)(30)(31). Similar to our findings, in the other studies, post-ictal headaches are more common than pre-ictal headaches which are often the migraine type and especially occur after some types of epilepsy such as generalized tonic-clonic and occipital lobe epilepsies (1,29,32,33). Limitations of this study were small sample size, prospective nature of the study and undifferentiated epileptic syndromes.…”

Tiagabine Synergistically Interacts with Gabapentin in the Electroconvulsive Threshold Test in Mice

“…Obviously, additional (antinociceptive) properties of TGB and GBP, administered in combinations, could ameliorate the patients' quality of living, especially those, who similar to healthy people, suffer from various pain disorders that are or not related with epilepsy, for instance: headaches, algomenorrhoea, etc. (Savoldi et al, 1984;Leniger et al, 2001;Nair et al, 2001). Due to this additional antinociceptive component, combinations of TGB with GBP might become much more efficacious from a clinical point of view.…”